Infant & Toddler Feeding
INFANT & TODDLERFEEDING from Birth to 23 MonthsMaking Every Bite CountThe first two years of your child’s lifeis important for proper growth anddevelopment. It is also critical forestablishing healthy dietary patterns for laterin life. You likely have many questions aboutthis important life stage including: what doyou feed a newborn infant?, when are infantsready for solid foods?, which foods shouldbe given and when?, how much food isenough? or when is the right time to introducepotentially allergenic foods, such as peanuts?This resource provides information on infant andtoddler feeding from birth through twenty-threemonths of age, including information on feeding,infant formula, the introduction of solid foods andinfant safety while eating. Keep in mind that everyinfant is different, and their diets may vary dependingon many factors such as age, stage of developmentand nutritional needs. Ask your pediatric nursepractitioner, pediatrician, registered dietitian or otherhealthcare provider for more specific feeding advice.
2NEWBORNSFor about the first six months of life, infantsshould be exclusively fed human milk, which isalso called feeding.1,2 Young infants are not readyfor solid foods. They are unable to safely swallowsolid foods and their stomachs are not able todigest solids well. When possible, feeding shouldbe continued through at least the first year oflife while introducing complementary foods; longerif desired.3,4 Iron-fortified infant formula is an optionif a mother has trouble feeding, or if human milk isunavailable or not compatible with the infant’s specificneeds. Infant formulas are designed to meet thenutritional needs of infants for the first year of life andare not recommended beyond age 12 months.Human milk can support your infant’s nutrient needsfor about the first six months of life, except for vitaminD and potentially iron. It’s generally recommendedto provide infants exclusively fed human milk withsupplemental vitamin D beginning soon after birth asthere are limited dietary sources of vitamin D. While itis possible for the body to make vitamin D after sunexposure, it is not recommended for infants to beexposed to direct sunlight.1,5Vitamin D supplementation should be continued unlessyour infant is consuming at least one liter per day (aboutone quart per day) of vitamin D–fortified formula. Anyinfant who receives less than one liter or one quart offormula per day needs an alternative way to get 400 IU/dayof vitamin D, as through vitamin D supplementation.5An infant is typically born with adequate iron supply forabout the first 6 months of life, depending on gestationalage, maternal iron status and timing of umbilical cordclamping. By age 6 months, however, infants exclusivelyfed human milk will require an external source of ironapart from human milk.Homemade InfantFormulaThe FDA regulates commerciallyavailable infant formulas, which comein liquid and powder forms, but it doesnot regulate recipes for homemadeformulas. The FDA strongly advisesparents and caregivers not to makeand feed their infants homemadeinfant formulas, as the potentialproblems with homemade formulasinclude contamination and absence of orinadequate amounts of critical nutrients.These problems are very serious, and theconsequences can be life-threatening.6Caregivers of infants exclusively fed human milkshould talk with their pediatric care provider aboutwhether there may be a need for supplementationwith iron before age 6 months. A complementaryfood source of iron beginning at about 6 monthsis particularly important for infants fed humanmilk because the iron content of human milk islow and a mother’s intake of iron during feedingdoes not increase its content.1
3Proper Handling And Storage OfHuman Milk And Infant Formula7 Wash hands thoroughly before expressinghuman milk or preparing to feed human milkor infant formula.If expressing human milk, ensure pump partsare thoroughly cleaned before use.If preparing powdered infant formula, use asafe water source and follow instructions onthe label.Refrigerate freshly expressed human milkwithin four hours for up to four days. Previouslyfrozen and thawed human milk should be usedwithin 24 hours. Thawed human milk shouldnever be refrozen.Refrigerate prepared infant formula for up to24 hours. Do not use a microwave to warm human milkor infant formula. Warm safely by placingthe sealed container of human milk or infantformula into a bowl of warm water, or underwarm, running tap water.Once it has been offered to the infant, use ordiscard leftovers quickly; within two hours forhuman milk or one hour for infant formula.Thoroughly wash all infant feeding items,including bottles and nipples. Considersanitizing feeding items for infants youngerthan 3 months of age, infants born prematurely,or infants with a compromised immune system.4 TO 6 MONTHSMost experts recommend starting solid foodssometime between four and six months of8age. These foods are called complementary foods.Remember, human milk or formula is still the mostimportant food for your infant during the first yearof life; at this age, solid (complementary) foods arenecessary to ensure adequate nutrition and exposureto flavors, textures and different types of foods.1Potentially allergenic foods, such as eggs, dairy,peanut, tree nuts, fish and shellfish, should beintroduced with other complementary foods atthis time.9,10 It is important that your infant’s firstfoods are mashed into small pieces to avoid potentialchoking hazards. Keep in mind it can take eight tofifteen times of trying a new food for an infant toaccept it.Iron rich foods, such as iron-fortified baby cereal orpureed meats, and zinc rich foods, such as meats,beans and zinc-fortified infant cereals, are goodfirst foods to introduce to infants4 to 6 months of age. Infantsexclusively fed human milkespecially benefit from earlierintroduction of iron- and zincrich foods. Honey should notbe consumed by infantsless than one year old.Give one new foodevery three tofive days andwatch for any
4unusual reactions. It is normal for an infant’s stool tochange color and/or consistency when eating newfoods, however a skin rash, diarrhea or vomiting maybe signs of a food allergy or intolerance. If you noticeany of these symptoms, stop feeding the new foodand tell your healthcare provider about the reaction assoon as possible; keep a diary of new foods introducedand any reactions.At first, your infant may not like the taste of solid food.Don’t be discouraged; you may first want to try givingthe food after your infant has taken a little humanmilk or formula. This way, feeding solid foods will beassociated with an enjoyable event, and your infant willeventually be eager to eat.Encourage your child to consume a variety of foods fromall food groups, except for foods and beverages withadded sugars and caffeine; foods and beverageshigher in sodium should also be limited.For healthy infants with adequate intake of human milk orinfant formula, supplemental water is typically not neededin the first six months. Small amounts of plain, fluoridateddrinking water can be given to infants who are at least 6months old as they learn to drink from a cup.11Infants may be ready to begin solids when: They are able to control their head and neckThey are able to hold their head up by themselfThey do not push food out of their mouth with their tongueThey sit up alone or with supportThey try to grasp small objects, such as toys or foodThey swallow food rather than pushing it back out onto the chinHow to feed your infant: If giving cereal, mix one tablespoon of cereal with 4-5 tablespoons of milk or formula.Use a small rubber coated spoon with a long handle to feed.Position your infant in a highchair sitting in front of you so you can see oneanother’s faces.Place about ½ teaspoon of cereal or pureed food on the back of your infant’stongue; this will help them suck the food off the spoon.Start with small serving sizes – one to two small spoonfuls at a time.What not to do during feedings: Do not put cereal in the bottle. Try not to feed your infant when you are in a hurry or distracted, or if he or sheis too tired. Do not force food when your infant is showing signs of fullness. Infants are fullwhen they turn their heads away from food or keep their mouth closed whenfood is offered.
5Vitamin and Mineral Supplementation1Infants may need supplemental iron and vitamin D, evenif they are growing well. Iron is needed to build red bloodcells and supports neurological development and immunefunction. Though infants are born with stored iron, it is usedup around six months of age; after that, an infant must receiveiron either through supplementation or iron-rich foods.Vitamin D is another important nutrient, as it is needed tobuild strong bones. The 2020-2025 Dietary Guidelines forAmericans recommends that infants exclusively fed humanmilk are also provided supplemental vitamin D beginning soonafter birth. The American Academy of Pediatrics recommendsthat all infants receive these nutrients either from food orsupplements. Check with your healthcare provider if you havequestions about vitamin D and iron supplements during thefirst year.Dietary Components to Limit1Avoid Added Sugars and Low-Calorie SweetenersThe 2020-2025 Dietary Guidelines for Americans(DGA) do not recommend the consumptionof low-calorie sweeteners or added sugarsby children younger than 2 years of age. Thisrecommendation is partly meant to help infantsand toddlers avoid developing a preference foroverly sweet foods during this formative phase.More specifically, infants and young children havevirtually no room in their diet for added sugars. Thisis because the nutrient requirements for infantsand young children are quite high relative to howsmall they are, and the amount of complementaryfoods they consume is small.Avoid Foods Higher in SodiumSodium is found in several foods, including some saltysnacks, commercial toddler foods and processedmeats. In addition to keeping sodium intake withinlimits for toddlers, another reason to avoid highsodium foods is that taste preferences for salty foodmay be established early in life.Avoid Honey and Unpasteurized Foodsand BeveragesInfants should not be given any foods containingraw or cooked honey. Honey can contain theClostridium botulinum organism that can causeserious illness or death among infants. Infantsand young children also should not be given anyunpasteurized foods or beverages; these includeunpasteurized juices, milk, yogurt, or cheeses, asthey could contain harmful bacteria.
6Homemade Baby FoodMetals and Your FoodMetals, like other naturally occurring elements,enter our food supply through our air, water andsoil. To help protect the safety of the food supply,the FDA monitors, tests, and sets standardsfor metals in foods. When the level of metalsis determined to be unsafe, the FDA uses itsauthority to take action on a case-by-case basis.12You may choose to make homemade babyfood for your infant; you may feed your infantraw, mashed bananas, but most other fruitsand vegetables should be cooked until theyare soft then mashed with a fork or blendedwith a food processor. Never add honey or cornsyrup to homemade baby food, and do not addsalt while cooking fresh foods for your infant.Always refrigerate leftover food, and look forsigns of spoilage before giving the food to yourinfant. Fresh foods will spoil more quickly thanfood from a can or jar.13Unlike the potential for foods to be contaminatedwith naturally occurring metals, some foodssuch as breakfast cereals and infant formula areintentionally fortified with metals like iron thatare beneficial to health.6 TO 8 MONTHSContinue to give milk or formula aswell as add thicker pureed fruits,vegetables, whole milk yogurt and meatsto your infant’s diet. Do not mix foodsuntil your infant has had every food in thecombination by itself. Zinc rich foods, suchas meats, beans and zinc-fortified infantcereals are important from age six monthsto support adequate zinc status, whichsupports growth and immune function.Iron rich foods such as iron-fortified babycereal or pureed meats are also essential.Between the ages of six to twelve months,infants may drink a small amount of wateras they learn to drink from a cup.12
7Food AllergiesIntroducing potentially allergenic foods with other complementaryfoods can help prevent food allergies and optimize an infant’slong-term health. The American Academy of Allergy, Asthma,and Immunology and the American Academy of Pediatricsrecommend introducing common food allergens at around 6months of age when other complementary foods are introduced;the 2020-2025 Dietary Guidelines for Americans echoes thisrecommendation.1,9,10 Introducing peanuts at or around 6 monthsof age can help reduce the risk of developing a peanut allergy.Infants who are at increased risk for a peanut allergy – thosewith egg allergies, severe eczema, or both, should receive theirfirst peanut-containing foods even earlier, between four andsix months. Dairy in the form of plain whole milk yogurt can beintroduced before a child’s first birthday, however, cow’s milk as abeverage, should wait to be introduced at 12 months old or later.It’s always recommended to consult with your healthcare providerif you have any questions or concerns about when to introducepotential allergens to your infant.8 TO 10 MONTHSAt this time, most infants are ready to eat moretextured foods such as mashed and dicedfoods. New foods, such as finger foods may beintroduced. Chop food into small bite size pieces.Ripe bananas, well cooked vegetables, and teethingbiscuits are all good choices. Avoid giving foodsthat can cause your infant to choke; uncookedvegetables or fruits (except bananas and avocados),chunks of cheese, whole grapes, peanuts, popcorn,and hot dog pieces should not be given. Poorlychewed food can block the airway and infantscannot cough or clear their throats well enough toremove the food.Your infant may begin finger foods when able to: Sit up straight in a high chair Grasp food with hands or fingertips Move food from hands to mouth10 TO 12 MONTHSYour infant is becoming more independent andmay be able to hold a spoon. Keep offeringnew foods; it can take eight to fifteen attempts oftrying a new food for an infant to accept it. Evenwithout all their teeth, infants can still use their gumsand tongue to mash food with lumps. Encourageresponsive feeding (see call out box) as much aspossible. While you are feeding your infant, name thefood and utensils being used, or colors of the food.Remember, each feeding is a special time for you tocommunicate together.The National Association of Pediatric NursePractitioners and the American Academy of Pediatricsrecommend feeding until at least one year of age.2,4feeding can be continued past this time if you andyour infant choose to do so.
8Plain, fluoridated drinking water intake can slowly beincreased after age one to meet hydration and fluorideneeds. Your infant should not consume cow’s milk orfortified soy beverages before age 12 months.Plant-based milk alternatives, which are sometimesreferred to as milk alternatives, include beverages madefrom plants, such as soy, oat, rice, coconut, and almond.These beverages should not be used in the first year oflife to replace human milk or infant formula. They maycome in different flavors and some forms have addedsugars. Unsweetened versions of these beverages may beaccommodated in small amounts in the diet during thesecond year of life, but most have significantly less proteinthan cow’s milk and are not always fortified with calciumand vitamin D. Among plant-based milk alternatives,only fortified soy beverage is currently considered a dairyequivalent. Thus, consuming other plant-based beveragesdoes not contribute to meeting dairy recommendations.1Safety at the PlateFollow these simple guidelines to help yourinfant stay safe while eating: Always supervise your infant whileeating; choking often occurs wheninfants are given foods that they arenot ready to eat. Cut foods into small pieces – 1/4 inch orsmaller, and place only a few pieces onthe plate at a time. Encourage your infant to take smallbites and chew food completely. It is important that your infant sits downwhen eating; never let your infant eatwhile lying down or walking.Responsive FeedingResponsive feeding is a term used to describe a feeding style that emphasizes recognizing and responding to the hungerand fullness cues of an infant or young child. Responsive feeding helps young children learn how to self-regulate their intake.Signs A ChildIs HungryOr FullBirth Through Age 5 MonthsA child may be hungry if he or she: Puts hands to mouth Turns head towardor bottle Puckers, smacks or licks lips Has clenched handsA child may be full if he or she: Closes mouth Turns head away from Relaxes handsAge 6 Through 23 MonthsA child may be hungry if he or she: Reaches or points to food Opens his or her mouth when offered aspoon or food Gets excited when he or she sees food Uses hand motions or makes sounds tolet you know he or she is still hungryA child may be full if he or she: Pushes food away Closes his or her mouth when foodis offered Turns his or her head away from food Uses hand motions or makes soundsto let you know he or she is still full
9HOW MUCH SHOULD MY INFANT EAT? 1,14These are typical portion sizes and daily intake for infants 6-12 months old.Age & Stage6 monthsGrains/CerealsFruitsVegetablesIron fortifiedinfant cerealProtein FoodsPortion SizesCooked, pureedCooked, pureedsingle fruits such as single vegetableStart with pureed,peaches, apricotssuch as carrots,strained, easy toPureed barley,peas, green beans,swallow foodsoatmeal,Mashed rawsquash, sweetamaranth, quinoa banana or avocado potatoAdd humancerealmilk, preparedformula or waterfor a thinnerconsistencyPureed meats, fish,poultry, legumes,tofuStart with 1-2 tbspone to two timesper dayWhole milk yogurt,with no added sugarWork up to 2-4 tbsptwo to three timesper day7-9 monthsSoft mashedmeats, fish, poultry,legumes, tofuLumpier oatmeal,iron fortifiedcerealsProgress textureto lumpy, coarselymashed or finely Dry “O” typechopped foodscerealPeeled mashedcooked fruitsPeeled mashedcooked veggiesContinue toincrease varietyContinue toincrease varietyStart to mix foodsBegin exploringBits of soft whole infant has triedself-feeding with grain breadsoft, mushy fingerSoft cooked pastafoodsStart to mix foodsinfant has triedSoft scrambled eggs,mashed slightlyPeanut or nut butter,thinned2-4 tablespoonstwo to three timesper dayWhole milk yogurt,no added sugarSoft scrambled eggsCottage cheese orother pasteurizedsoft cheesesPeanut or nut butter,thinned8-12 monthsWhen ready, addmore soft fingerfoodsInfant can joinfamily mealsBegin introducingtable foods/combinationfoods with“smush”consistencyWhole grainno-added sugarcereal, puffs,pasta, brown rice,quinoa, wholegrain tortillaSmall pieces ofSmall pieces ofcooked or soft fruit, cooked or softskins removedveggies, skinsremovedSmall pieces of softcooked meals, fish,tofu, legumes, eggand soft pasteurizedcheeseWhole milk yogurt,no added sugar4-8 tablespoonsthree times per dayOptional snack (2-4tablespoons twicea day)Peanut or nut butteron soft bread*Some foods to avoid that can bea choking hazard: chunks of meator cheese, hot dogs, sausages,popcorn, seeds, nuts, chuncksof peanut butter, whole grapesor cherry tomatoes, hard orsticky candy, chewing gum, rawvegetables or fruit chunks. No needto add salt or sugar. Honey shouldbe avoided before 12 months.
10CONSIDERATIONS FOR 12-23 MONTHSWhole cow’s milk – up to 16-24 ounces per day,should only be introduced after your infantturns one year old.15 Young infants cannot digest cow’smilk as easily as milk or formula. This is because cow’smilk contains higher amounts of protein and someminerals. After age 12 months, the fat in whole milk isimportant for proper growth and development. Low-fatdairy should not be given until two years of age unlessyour healthcare provider recommends it. If your infant isput on a special formula for a milk allergy or intolerance,talk to your healthcare provider before introducing dairy.After the age of twelve months, if you choose to givejuice, it should only be 100% fruit juice. Juice shouldnot replace the amount of milk or formula your childor toddler is drinking. Limit juice to no more than fourounces a day and offer it only with a meal or snack. If youoffer juice, serve it in a cup, never in a bottle or sippy cupas this can lead to tooth decay.16Sugar-sweetened beverages – regular soda, juicedrinks that are less than 100% fruit juice, sports drinks,and flavored water with sugar, should not be given tochildren younger than age two. Drinks labeled as fruitdrinks or fruit-flavored drinks may contain added sugarsor low-calorie sweeteners and are not the same as 100%fruit juice.There are no clear needs for special milks or drinks specificallymarketed for toddlers. Toddler milk and drinks are drinkssupplemented with nutrients and typically contain addedsugars. Necessary nutrients can be obtained from cow’smilk or a fortified soy beverage and appropriate solid foods.Concerns exist about potential negative health effects ofcaffeine for young children, and no safe limits of caffeinehave been established for this age group.A Message from the National Association ofPediatric Nurse Practitioners (NAPNAP)The National Association of Pediatric Nurse Practitioners“Alexa, Enable theMyPlate Skill”(NAPNAP) is the nation’s only professional association forpediatric-focused advanced practice registered nurses (APRNs)dedicated to improving the quality of health care for infants,children, adolescents and young adults through evidence-MyPlate is now available onAlexa! Get MyPlate nutritioninformation for infants andtoddlers straight to your home on an AmazonAlexa device, on your smartphone or tablet via thefree Amazon Alexa app. MyPlate on Alexa provideshealthy eating tips for parents and caregivers onwhat and how to feed infants and toddlers basedon their age (between four to 24 months). Parentsand caregivers can receive science-based food andnutrition advice to set their child up for lifelonghealthy eating habits. To get started, simply say“Alexa, enable the MyPlate skill” into an Alexa smartspeaker or the free Alexa mobile app. To learn morevisit: https://www.myplate.gov/myplateassistant18based practice. Our members include clinicians in primary,acute and specialty care, faculty, researchers and authors.They diagnose and treat pediatric illnesses, perform pediatrichealth care maintenance, prescribe medications and therapies,screen and manage mental health illnesses, order and interpretdiagnostic tests, mange acute, chronic and critical pediatricdiseases, and more. Representing more than 8,000 healthcarepractitioners with 18 special interest groups and 53 chapters,NAPNAP has been advocating for children’s health since 1973and was the first APRN society in the U.S. Our mission is toempower pediatric-focused advanced practice registerednurses and key partners to optimize child and family health.Learn more at napnap.org.
REFERENCES1. 2020 Dietary Guidelines Advisory Committee andNutrition Evidence Systematic Review Team. The Duration,Frequency, and Volume of Exclusive Human Milk and/orInfant Formula Consumption and Overweight and Obesity:A Systematic Review. 2020 Dietary Guidelines AdvisoryCommittee Project. Alexandria, VA: U.S. Department ofAgriculture, Food and Nutrition Service, Center for NutritionPolicy and Promotion, July 2020. Available at: sory-committeesystematic-reviews.Development of Atopic Disease in Infants and Children: TheRole of Maternal Dietary Restriction, feeding, HydrolyzedFormulas, and Timing of Introduction of AllergenicComplementary Foods. Pediatrics, 143(4), e20190281.2. Section on feeding (2012). feeding and the use of humanmilk. Pediatrics, 129(3), e827–e841. https://doi.org/10.1542/peds.2011-355211. Sciences, N. A. of. (2020, July 8). Feeding infants andchildren from birth to 24 months: Summarizing existingguidance. Summarizing Existing Guidance The NationalAcademies Press. Retrieved from and-children-from-birth-to24-months-summarizing.3. World Health Organization. (n.d.). feeding. World HealthOrganization. Retrieved from: https://www.who.int/healthtopics/feeding#tab tab 1.4. National Association of Pediatric Nurse Practitioners(NAPNAP). (2019). Position statement on feeding, Journal ofPediatric Health Care. Retrieved from: -6/fulltext5. Wagner, C. L., & Greer, F. R. (2008). Prevention ofrickets and vitamin D deficiency in infants, children, andadolescents. PEDIATRICS, 122(5), 1142–1152.6. Center for Food Safety and Applied Nutrition. (2021,February 24). FDA advises parents and caregivers to notmake or feed homemade infant. U.S. Food and DrugAdministration. Retrieved from make-or-feed-homemade-infantformula-infants#: :text h%20and%20safety%20concerns.&text ants%20homemade%20infant%20formulas.7. Centers for Disease Control and Prevention. (2021, June11). Proper storage and preparation of milk. Centers forDisease Control and Prevention. Retrieved from ng milk.htm.8. Kleinman R. E. (2000). American Academy ofPediatrics recommendations for complementaryfeeding. Pediatrics, 106(5), 1274.9. Greer, F. R., Sicherer, S. H., Burks, A. W., COMMITTEE ONNUTRITION, & SECTION ON ALLERGY AND IMMUNOLOGY(2019). The Effects of Early Nutritional Interventions on the10. Prevention of allergies and asthma in children. AmericanAcademy of Allergy Asthma & Immunology. (n.d.).Retrieved from sthma-in-children.12. Center for Food Safety and Applied Nutrition. (2021,April 8). Metals and your food. U.S. Food and DrugAdministration. Retrieved from es-food/metals-and-your-food.13. Starting solid foods. HealthyChildren.org. (2021, March17). Retrieved from .aspx.14. Sample menu for a Baby 8 to 12 months old.HealthyChildren.org. (2021, March 17). Retrieved Menu-for-an-8to-12-Month-Old.aspx.15. Lott M, Callahan E, Welker Duffy E, Story M, & Daniels S.(2019, September 1). Consensus statement. healthy beverageconsumption in early childhood: Recommendations from KeyNational Health and Nutrition Organizations. Healthy EatingResearch. Retrieved from and-nutrition-organizations/.16. Policy on Early Childhood Caries (ECC): Consequences andPreventive Strategies. America’s Pediatric Dentists. (2021).Retrieved from ions-consequences-and-preventive-strategies/.17. MyPlate on Alexa. MyPlate. (n.d.). Retrieved from https://www.myplate.gov/myplateassistant.
This resource provides information on infant and toddler feeding from birth through twenty-three months of age, including information on feeding, infant formula, the introduction of solid foods and infant safety while eating. Keep in mind that every infant is different, and their diets may vary depending
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Infant Feeding Counselling Cards This counselling card flip chart is based on the National Infant and Young Child Feeding Policy. These counselling cards have been created to help health workers trained in infant feeding counselling to support HIV-positive mothers. All HIV-positive mothers should receive counselling on how to feed their babies.
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Infant & Young Child feeding from an Indian perspective (including Human Milk Banking, infant feeding in the HIV situation and Micronutrients). Recommendations: Appropriate and Optimal Infant and Young Child Feeding: Early initiation of breastfeeding, exclusive breastfeeding for the first six
the protection, promotion, and support of optimal infant and young child feeding practices is a priority lifesaving intervention. Infant feeding practices in Lebanon fall short of recommendations. In Lebanon, there's a lack of national-level data on nutrition among the Lebanese population routine infant and young child feeding practices
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